Operative monitoring of parathyroid gland hyperfunction
| Autor: | David L. Prudhomme, Victor D. Dembrow, George L. Irvin |
|---|---|
| Rok vydání: | 1991 |
| Předmět: |
Parathyroidectomy
medicine.medical_specialty Time Factors medicine.medical_treatment Parathyroid hormone Predictive Value of Tests Monitoring Intraoperative medicine Humans Whole blood Immunoradiometric assay business.industry Hyperparathyroidism Multiple Endocrine Neoplasia General Medicine Ablation Surgery medicine.anatomical_structure Parathyroid Hormone Predictive value of tests Hypercalcemia Parathyroid gland Immunoradiometric Assay business hormones hormone substitutes and hormone antagonists Hormone |
| Zdroj: | American journal of surgery. 162(4) |
| ISSN: | 0002-9610 |
| Popis: | With a 20-year experience of more than 700 parathyroidectomies, our persistent hypercalcemic postoperative failure rate of 7% has remained constant. Reasons for failure have been misdiagnosis or inability of the surgeon to detect and excise all hypersecreting glands. We have modified a commercially available immunoradiometric assay for intact parathyroid hormone (PTH) resulting in a 15-minute turnaround time. Since intact PTH has a half-life measured in minutes, whole blood samples taken 10 minutes after gland excisions were monitored intraoperatively to confirm significant changes in circulating hormone. Quantitative evidence that all hyperfunctioning parathyroid tissue had been ablated during operation was obtained in 19 of 21 patients. Less than four glands each were identified in 53% of these patients. The PTH “quick” test correctly pointed to an inadequate excision requiring further parathyroid ablation in two patients, made bilateral neck exploration unnecessary in two patients who had previously undergone parathyroidectomy, and predicted persistent hypercalcemia in two patients with complications. |
| Databáze: | OpenAIRE |
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